- Rexel USA (Santa Clara, CA)
- …understanding freight and incoterms, as well as a basic understanding of terms and conditions risk in order to assess project risk + Read through all Purchase ... vendors, customers, and sales teams on pricing, order placement, claims and returned goods, and account management to ensure...- up to 20% + Exposed to electrical hazards; risk of electrical shock Occasionally - up to 20%… more
- Banner Health (CA)
- …coding expertise to resolve issues and support appropriate reimbursement. Proficiency in claims software to address coding edits and claim denials utilizing multiple ... of trends in DRG (MS/APR-DRG), APC, HCC, other Heath Risk Adjusted Factors, National Correct Coding Initiative (NCCI) and...and must be familiar with coding and abstracting software, claims processing tools, as well as common office software… more
- Evolent (Sacramento, CA)
- …found by testing teams during test execution + Consult with the manage and report risk , issues, and decisions with the lead / manager + Responsible to attend and if ... - Payer side, Knowledge of Medicare, Medicaid, Commercial Plans and understanding on claims workflow, members, providers + A minimum of 1 years of experience in… more
- CVS Health (Sacramento, CA)
- …day. **Position Summary** -Responsible for initial review and triage of claims tasked for review. -Determines coverage, verifies eligibility, identifies and ... accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements. -Protects the confidentiality of… more
- LA Care Health Plan (Los Angeles, CA)
- …Health Care Services (DHCS), Department of Managed Health Care (DMHC), Managed Risk Medical Insurance Board (MBMIB) and National Committee for Quality Assurance ... and provider complaint and appeals issues, including eligibility, access to care, claims , benefit, and quality of care concerns. Experience working with firm… more
- Stanford University (Stanford, CA)
- …cost and performance, and ensure accurate and timely plan administration, claims payment, manage escalated issues, etc. + Manage monthly billings, enrollments, ... management; coordinate data gathering for audits; oversight of benefit plan claims , funding, and premium payments. Assist in preparing financial information for… more
- Rady Children's Hospital San Diego (San Diego, CA)
- …offices), answering the phone (including all provider calls regarding authorization processing, claims related phone calls, and any other calls received via the ... such as hospital, medical group, health insurance, or other Risk Bearing Organization (RBO) Knowledge of medical terminology, ICD-10...codes, CPT Codes, HCPC Codes, Health Plan benefits, or claims **The current salary range for this position is… more
- Sharp HealthCare (San Diego, CA)
- …with medical management such as provider relations, member services, benefits and claims management, etc. Assists (as determined by the plan Chief Medical Officer) ... review and analysis of Plan performance from summary data of paid claims , encounters, authorization logs, complaint and grievance logs and other sources. +… more
- CVS Health (Sacramento, CA)
- …work with a collaborative, close-knit team on pharmacy and member specific claims data including, but not limited to, financial and operational information ... activities, tracking completion of action items, resolving issues, and mitigating risk + Champion a culture of continuous improvement, curiosity, collaboration, and… more
- Elevance Health (Costa Mesa, CA)
- …+ Performs in-depth investigations on identified providers as warranted. + Examines claims for compliance with relevant billing and processing guidelines and to ... prevention and control. + Review and conducts analysis of claims and medical records prior to payment. Researches new...concern. + Recommends possible interventions for loss control and risk avoidance based on the outcome of the investigation.… more